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NPI Code Detail

MEDICARE: ICL TREATMENT APARTMENT PROGRAM

MEDICARE: ICL TREATMENT APARTMENT PROGRAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245488865
Entity Type Code : Organization
Provider Name (Legal Business Name) : ICL TREATMENT APARTMENT PROGRAM
Provider Business Mailing Address
First Line : 40 RECTOR ST FL 11
Second Line :
City : NEW YORK
State : NY
Zip : 10006-1705
Country : US
Telephone Number : 212-385-3030
Fax Number :
Provider Business Practice Location Address
First Line : 50 NEVINS ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-1004
Country : US
Telephone Number : 718-855-4035
Fax Number :
Authorized Official
Title or Position : C F O
Name : MR. DEWEY HOWARD
Credential :
Telephone Number : 212-385-3030
Provider Enumeration Date : 09/08/2008
Last Update Date : 09/08/2008

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Directions to “ICL TREATMENT APARTMENT PROGRAM ” Practice Location

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